OBJECTIVE: To develop a consensus-based set of generic competencies in antimicrobial prescribing and stewardship for European prescribers through a structured consensus procedure. METHODS: The RAND-modified Delphi procedure comprised two online questionnaire rounds, a face-to-face meeting between rounds, and a final review. Our departure point was a set of competencies agreed previously by consensus among a UK multi-disciplinary panel, and which had been subsequently revised through consultation with ESCMID Study Group representatives...

OBJECTIVES: Parapneumonic pleural effusions/empyema (PPE/PE) are severe complications of community- acquired pneumonia. We investigated the bacterial aetiology and incidence of paediatric PPE/PE in Germany after the introduction of universal pneumococcal conjugate vaccine (PCV) immunisation for infants. METHODS: Children <18 years of age hospitalised with pneumonia-associated PPE/PE necessitating pleural drainage or persisting >7 days were reported to the German Surveillance Unit for Rare Diseases in Childhood from October 2010 to June 2017...

Didymella microchlamydospora is a recently established species usually causing plant diseases. This report represents the first case of invasive pulmonary infection due to this fungus in a 50-year-old male with history of immunosuppression. Patient infection improved by prescribing voriconazole.

OBJECTIVES: We conducted a cluster-randomised feasibility trial of 90-minute Chlamydia trachomatis tests and same day on-site treatment ("Test n Treat/TnT") in six technical colleges in London, England to assess: • TnT uptake rates • Follow-up rates • Prevalence of C.trachomatis at baseline and 7-months • Time to treatment • Acceptability of TnT METHODS: Participants completed questionnaires and provided genitourinary samples at baseline and seven months. Participants were informed that baseline samples would not be tested for 7- months and advised to get screened independently...

Recent reports highlight a growing awareness of the potential for Chlamydia considered to be traditionally veterinary pathogens to cause cases of community-acquired pneumonia in humans. Cases of Chlamydia caviae, a guinea pig pathogen, were detected in individuals with serious pneumonia requiring hospitalisation. Source tracking linked these infections to pet guinea pigs. Studies of horses have found that the avian and zoonotic pathogen, Chlamydia psittaci, may be more common in these mammalian hosts, further highlighting the risk of exposure to chlamydial causes of CAP...

OBJECTIVE: The aim of the present work was to use a semi-mechanistic, mathematical, PK-PD model developed from in-vitro time-kill measurements with P. aeruginosa to compare different pharmacodynamic indices derived from simulated human avibactam exposures, with respect to their degree of correlation with the modeled bacterial responses. METHODS: A mathematical model of the effect of ceftazidime-avibactam on the growth dynamics of P. aeruginosa was used to simulate bacterial responses to modeled human exposures from fractionated avibactam dosing regimens with a fixed ceftazidime dosing regimen (2 or 8 g q8h as 2-h infusion)...

OBJECTIVES: The purpose of this study was to compare the efficiency of mould identification of two MALDI-TOF MS systems - Vitek MS and Microflex LT - and the MSI application. METHODS: Moulds were collected retrospectively and prospectively to display epidemiological diversity of a microbiology lab. All of them were identified via sequencing. Strains were then identified using the VMS v3.0, the MLT and the MSI software applied on MLT spectra. Rates of correct identifications to the species, to the complex level and to the genus level were compared to the molecular Gold Standard...

OBJECTIVES: Highly pathogenic viruses such as Ebola virus are a threat to routine laboratory workers. Inactivation procedures with Triton X-100 0.1% and/or heat are currently recommended, but have unknown effects on the accuracy of serological testing. Furthermore, virus inactivation by Triton X-100 0.1% was shown to be ineffective in serum. This study aimed to demonstrate virus inactivation in serum by Triton X-100 1% and maintained accuracy of serological testing. METHODS: A panel of 19 serological tests was run on patient serum samples after treatment with Triton X-100 1%, 0...

OBJECTIVE: Rapid detection of macrolide resistance-associated mutations in Mycoplasma pneumoniae is crucial for effective antimicrobial treatment. In this study, we evaluated the Lightmix® Mycoplasma macrolide assay for the detection of point mutations at nucleotide position 2063 and 2064 in the 23S rRNA gene of M. pneumoniae that confer macrolide resistance. METHODS: Samples from 3438 patients suffering from respiratory tract infection were analyzed by M. pneumoniae real-time polymerase chain reaction (RT-PCR), and 208 (6%) of them were tested positive...

OBJECTIVES: We evaluated treatment outcomes and predictors for poor treatment outcomes for tuberculosis (TB) among native- and foreign-born patients with drug-susceptible TB (DSTB) in the Netherlands. METHODS: This retrospective cohort study included adult patients with DSTB treated from 2005 to 2015 from a nationwide exhaustive registry. Predictors for unsuccessful treatment outcomes (default and failure) and TB-associated mortality were analysed using multivariate logistic regression...

OBJECTIVES: To investigate the incidence, risk factors, clinical course and outcomes of pregnancy-related group A streptococcus (GAS) infection. METHODS: A retrospective 13-year cohort study of culture-proven pregnancy-related GAS infection was performed at two university hospitals, serving heterogeneous, multicultural, urban and rural populations. RESULTS: Of 124 women diagnosed with pregnancy-related GAS infection, 115 (93%) were in the puerperium, an incidence of 0...

OBJECTIVES: Broad-range PCR has the potential to detect virtually any bacterial species via amplification and nucleotide sequencing of a DNA region common to all bacteria. We aimed to evaluate its usefulness and clinical relevance when applied to a wide variety of primary sterile materials. METHODS: A prospective study including 1370 samples (75 heart valves, 151 joint tissue samples, 230 joint aspirates, 848 whole blood samples and 66 culture negative cerebrospinal fluid samples) were studied by using a commercial PCR system for detecting 16S rDNA (Molzym)...

OBJECTIVES: A stool sample is the sample of choice for microbiological testing of enteric pathogens causing diarrhoea, but a rectal swab can be a more practical alternative. A prospective observational study was performed to evaluate the diagnostic performance of flocked rectal swab specimens using the syndromic molecular approach to determine the aetiology of diarrhoea in adults. METHODS: We compared the performance of rectal swabs with stool samples as the reference standard in determining viral, bacterial and protozoal pathogens using real-time multiplex PCR as well as standard stool culture...

OBJECTIVES: Congenital toxoplasmosis (CT) affects 1-10 fetuses/10,000 live newborns in western countries. Without knowing pre-conception serostatus, it is hard to date the infection when anti-Toxoplasma IgG and IgM antibodies are positive at first screening. While a high IgG avidity index (AI) in the first trimester excludes CT, the same cannot be said of intermediate and low AI. The aim of this study was to estimate the risk of CT when intermediate or low AI is detected in the first trimester of pregnancy...

OBJECTIVES: Recently, following import by travel and migration, epidemic community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has caused nosocomial outbreaks in Europe, sometimes with a fatal outcome. We describe clinico-epidemiological characteristics of CA-MRSA detected by the European Network for the Surveillance of imported S. aureus (www. staphtrav.eu) from May 2011- November 2016. METHODS: Sentinel surveillance at thirteen travel-clinics enrolling patients with travel-associated skin and soft tissue infection (SSTI) and analysing lesion and nose swabs at one central laboratory...

OBJECTIVES: In Germany, previous reports have demonstrated transmitted human immunodeficiency virus type 1 (HIV-1) drug-resistance mutations (DRM) in 11% of newly diagnosed individuals, highlighting the importance of drug-resistance screening before the initiation of antiretroviral therapy (ART). Here, we sought to understand the molecular epidemiology of HIV DRM transmission in the Cologne-Bonn region of Germany, given one of the highest rates of new HIV diagnoses in western Europe (13...

INTRODUCTION: Although solid organ transplant (SOT) recipients with pretransplant serology for cytomegalovirus (CMV-R+) are considered at intermediate risk for CMV infection post transplantation, CMV infection remains a major cause of morbidity in this population. We prospectively characterized whether having pretransplant CMV-specific cellular immunity is independently associated with controlling infection after transplantation in R + SOT recipients. METHODS: A prospective cohort of consecutive R + SOT recipients that received pre-emptive treatment for CMV infection was monitored after transplantation and variables were recorded during the follow-up...